Muslim Atiq, Muzaffar Latif Gill, Nasir Khokhar, Javed Aslam Butt.
Small bowel vascular insufficiency presenting as abdominal pain.
Rawal Med J Jan ;29(1):42-3.

This 57 years old gentleman was admitted through the Emergency Room with the complaints of sudden onset of epigastric pain associated with nausea and vomiting. Pain was severe in intensity, radiating to the left side. He was thoroughly investigated elsewhere and was discharged on NSAIDs. On examination, patient was very anxious and restless. Abdominal examamination revealed tenderness with an ill defined mass in the epigastric region. Laboratory data showed hemoglobin of 12.8 mg/dl and a white blood cell count of 16,200/ul. Suspecting acute pancreatitis, serum amylase levels were done which were in the normal range. During the hospital stay, patient had two episodes of vomiting which was coffee ground in color. This prompted an upper GI endoscopy, which showed smoky colored, bluish, angry looking small bowel. A presumptive diagnosis of small bowel ischemia was made and laparotomy was performed. Intraoperative findings confirmed the diagnosis. Around 30 cm of jejunum was found ischemic and this segment was totally gangrenous. The necrotic small bowel was resected and an end-to-end anastomosis was performed. Post operatively, the patient did fine and went home.

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